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ARTICLE # 2: Discussion

Tiredness and Somnolence Despite Initial Treatment
of Obstructive Sleep Apnea Syndrome

(What to Do When an OSAS Patient Stays Hypersomnolent Despite Treatment)

A Reader with Persistent EDS:
"I use the nasal pillows which I keep on 98% of the time...I wake up very tired and still feel sluggish during the day and still sleep the weekends away...the doctor says that the sleep clinic won't pay for another sleep study until a year after the first. I feel as if I have run into a brick wall...also I have gained...20 pounds since beginning treatment..."
My Response:
It sounds like your sleep disorder is not being controlled by your current treatment. In that case there should be no hard rule that you can't have a repeat sleep study sooner than a year later. Do you have other signs of persistent apnea such as snoring or choking and gasping at night, drooling on the pillow, morning headaches, hypertension, or impaired memory? Your weight gain may have increased the CPAP pressure you need. Also, ask the clinic for a copy of your sleep study and whether that CPAP study showed any sign of periodic leg movements of sleep or unexplained arousals. These should be evident from the study. It is also possible to have sleep apnea plus narcolepsy, which might not be so evident, but might show up in the form of a REM latency even shorter than that typical of depression. Just showing the clinic a sophistication about such issues will make them more careful about treating your complaints lightly.

Another Viewer's Comments:
"...the clinic could have been trying to say that his insurance would not cover it till a year had passed...if he was silling to pay out of pocket, then it would be possible...accredited sleep labs are fairly rare...a particular clinic might limit the period between studies to allow everyone a chance to get in. Twenty pounds up or down is not that unusual so it would likely not qualify for special treatment...an alternative might be to consider a non-accredited facility...Finally - there are some self-help measures he might be able to take...putting bricks under the legs at the head of the bed will raise his upper torso and...often...lower[s] CPAP pressure needs...and if he is able to reach the controls on his machine, he might try setting it slightly higher..."
My Response:
I can agree with all of the above except that I wouldn't recommend resetting one's own CPAP pressures. I have done that and I found myself quite confused by the process, which strikes me as rather like prescribing one's own medication. Also, most sleep doctors and home care companies specifically forbid that and doing it in spite of their advice puts one in a position of being unable to frankly discuss with them the relationship of treatment to response, which they need to know if they are to help. The idea about elevating the head of the bed is, on the other hand, intriguing; it is pretty well known that lying on one's back aggravates sleep apnea, but not so well known that elevating one's torso (like sleeping on one's side or stomach) lessens the problem.

Another Reader Remarks:
"I've noticed in reading the sleep apnea literature they they often refer to problems related to patient compliance...without seeming to wonder about why this happens...it is really hard to get appropriate treatment...over the past year, I lost a lot of weight--and in order to keep my pressure at the right setting--I would have had to have a sleep study about every other week...it took a month to get an appointment, then a 2 months wait for a sleep study...I've felt like hell for months now, when all I really need is a re-titration...It's been well over a year since I've been at the correct pressure...it doesn't work when it's almost impossible to get it re-titrated."